Pharmacotherapeutics of Opportunistic infections in HIV patients

2. Opportunistic infections (OIs) are infections
that occur more often or are more severe in
people with weakened immune systems
(people living with HIV) than in people with
healthy immune systems.

3.  About 90% of HIV-related morbidity and
mortality is due to opportunistic infections in
World
 In one study it was found that Tuberculosis was
the most frequent opportunistic infections
accounting for 50% of all opportunistic
infections, followed by Candidiasis in 49% of
cases. Pneumocystosis was seen in 16%,
Cryptococcal infection in 09% and parasitic
diarrhoea in 15% in India

4.  Elders
 Malnutrition
 Patients with HIV
 Patients with Inflammatory bowel disease
 Patients with Leukopenia
 Patients with diabetes mellitus
 Patients who uses immunosupressants

5. Fungal infections
 P. jiroveci Pneumonia
 Oropharangeal Candiasis
 Cryptococcus neoformans infection
Protozoal infections
 Toxoplasmosis
 Cryptospordiasis
Bacterial infection
 Mycobacterium Tuberculosis
Viral infection
 Cytomegalo virus infection

7. Cause: Pneumocystitis jerovecii (Yeast like fungus)
Clinical Presentation:
 Non productive cough
 Shortness of breath on exertion
 Inability to take deep breath
 Fever
 Anorexia
 Weight loss
Diagnosis:
 Exercise induced oxygen desaturation
 Chest radiographic appearance of bilateral interstitial shadowing
 Nucleic acid amplification technique
 Bronchoalveolar lavage
 CD4 count is less than 200cells/mm3

8. Cause: Candida albicans (Fungus)
Clinical Presentation:
 White plaques on oral mucosa
 Erythamatous plaques on oral mucosa
 Angulus chelitis
 Dysphagia
 Odynophagia
Diagnosis: Based on clinical presentation

9. Cause: Cryptococcus neoformans (Fungus)
Clinical Presentation:
 Fever
 Head ache
Diagnosis:
 CSF analysis
 Blood culture

10. Cause: Toxoplasma gondii (Protozoa)
Clinical Presentation:
 Fever
 Head ache
 Confusion
 Seizures
Diagnosis:
 CT Scan-Ring Enhancing Lesion
 Brain biopsy

11. Cause: Cryptospordium parvum (Protozoa)
Clinical Presentation:
 Abdominal pain
 Diarrhea
 Weight loss
Diagnosis:
 Stool analysis

12. Cause: Mycobacterium tuberculosis (Bacteria)
Clinical Presentation:
 Persistent cough
 Coughing with blood
 Chest pain while coughing and breathing
 Unintentional weight loss
 Fatigue
 Fever
 Night sweats
 Chills
Diagnosis:
 Tuberculin test
 Sputum Culture

13. Cause: Cytomegalovirus (Virus)
Clinical Presentation:
 Blurred vision
 Visual field defects
 Blindness
Diagnosis: Based on clinical presentation

14. P.jerovecii
Inhalation
Enter in to HIV patient
Residing in alveoli
Multiplication of P. jerovecii
Alteration of alveolar capability
Impairment of gaseous exchange
Ventilation - Perfusion mismatch
Respiratory Arrest

15. T.gondii
Food
Enter in to HIV patient
Reach to CNS via systemic circulation
Perivascular inflammatory response
Fibrosis or Necrosis
Hemorrhage or Thrombosis
Neurological signs and symptoms

16. Coughing and Sneezing of Patients with active pulmonary TB
Generate droplet nuclei of M. tuberculosis
Enter in to lungs of HIV patients
Bacteria is deposited in terminal airways (alveoli) and
ingested by macrophages
Inflammatory changes in lungs
TB spreads to remaining organs

17. Cytomegalovirus
Enter in to body of HIV patient through saliva, breast milk and genital secretion
Reach to eye via systemic circulation
Inflammatory response in eye
Edema, Hemorrage
Necrosis
Diminished visual acuity
Blindness

18.  Acute Respiratory Distress Syndrome
(ARDS)
 Encephalitis
 Meningitis
 Blindness

25. Drug Category Mode of Action Dose Adverse Effects
Trimethoprim
+
Sulpha
methoxazole
Sulphonamides Inhibit folic acid
synthesis in bacteria
Moderate–severe:
120mg/kg i.v in 2–4
divided doses for 3
days, then 90mg/kg
for 18 days
Mild: 1920mg p.o.
three times daily
for 3 weeks
Prophylaxis: 480 or
960mg p.o. daily or
960mg three times
per week (960mg
daily if on
rifampicin)
 Nausea
 Vomiting
 Diarrhoea
 Rash
 Hyperkalaemia
Dapsone Antileprosy
Agents
Inhibit folic acid
synthesis in bacteria
100mg p.o. daily
(with trimethoprim
10–15mg/kg/ day in
divided doses for 3
weeks for PCP
treatment)
 Anorexia
 Nausea
 Vomiting
 Rash
 Dapsone syndrome

26. Clindamycin Lincosamide Inhibit protein
synthesis in
bacteria
600mg i.v./p.o. four
times daily for 3
weeks
600mg i.v./p.o. four
times daily for at
least 6 weeks 1.2g
p.o. daily in 3–4
divided doses
 Diarrhoea
 Abdominal
discomfort
Oesophagitis
 Abnormal LFTs
 Thrombophlebitis
Primaquine Anti malarial
drug
Disrupts
Plasmodium
mitochondria
15–30mg p.o. daily
for 3 weeks
 Nausea
 Vomiting
 Anorexia
 Abdominal pain
 Haemolytic anaemia

27. Flucanazole Anti fungal
drug
Disrupts fungal cell
membrane
100mg p.o. daily
for 2 weeks 50mg
p.o. daily for 7–14
days 400mg i.v./p.o.
daily for ≥8 weeks
200mg p.o. daily
 Headache
 Abdominal pain
 Diarrhoea
 Flatulence
 Abnormal LFTs
Amphotericin B Anti fungal drug Disrupts fungal cell
membrane
Test dose of 1mg
i.v. (over 10–30min,
depending on
product), followed
by once daily i.v.: 1.
0.25–1.0mg/kg
(increased over 3–5
days as tolerated)
2. 1–3.0mg/kg
(increased over 2–3
days) 3. 5mg/kg.
Duration: 2–6
weeks (total
induction period at
least 6 weeks)
 Fever
 Weight loss
 Myalgia
 Thrombophlebitis
 Epigastric pain

28. Flucytosine Anti fungal
agent
Inhibit protein
synthesis in fungus
100mg/kg daily
p.o./i.v. in four
divided doses for 2
weeks (with i.v.
amphotericin)
 Nausea
 Vomiting
 Diarrhoea
 Rash
 Hepatotoxicity
Sulphadiazine Sulphonamide Inhibit folic acid
synthesis in bacteria
1–1.5g i.v./p.o. four
times daily for at
least 6 weeks. 2g
p.o. daily in divided
doses
 Nausea
 Vomiting
 Rash
 Bone marrow
suppression
 Crystalluria
Pyrimethamine Antimalarial
agent
Inhibit folic acid
synthesis in parasite
100mg on day 1,
then 50mg p.o.
once daily for at
least 6 weeks
Different in SPC
25mg p.o. once
daily
 Anaemia
 Leucopenia
 Thrombocytopenia
 Rash

29. Nitazoxanide Anti Parasitic
agent
Inhibits growth of
sporozoites and
oocysts of
Cryptosporidium
and trophozoites of
Giardia
500 mg PO q12hr
x 3 days
 Headache
 Abdominal pain
 Diarrhea
 Nausea
 Chromaturia
Cidofovir Anti viral agent Inhibits DNA
synthesis in virus
5mg/kg weekly for
two doses, then
every 2 weeks
thereafter
 Infection
 Chills
 Fever
 Headache
 Amnesia
 Anxiety
Atovaquone Anti malarial
agent
Inhibits electron
transport chain in
Plasmodium
750mg p.o. twice
daily with food for
3 weeks 1.5g p.o.
twice daily for at
least 6 weeks
 Diarrhoea
 Insomnia
 Increased LFTs
 Decreased sodium
 Anaemia

30.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931281/
pdf/nihms796285.pdf
 www.ijmm.org/temp/IndianJMedMicrobiol33178-
2534228_070222.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055535/
pdf/nihms-545048.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820438/
pdf/1471-2180-10-11.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877069/
pdf/pone.0083643.pdf